The Coalition against Typhoid Secretariat Convenes the 9th International Conference on Typhoid and Invasive NTS Disease

From April 30 to May 3, the Coalition against Typhoid (CaT) Secretariat, with coordination and support from PT Bio Farma, convened nearly 250 participants from 36 countries for the 9th International Conference on Typhoid and Invasive Non-Typhoidal Salmonella (iNTS) Disease. This four-day event, held in Bali, Indonesia, was the largest conference in CaT’s history.

Throughout the conference, prominent clinicians, scientists, policy makers and public health practitioners shared new research and pathways forward for typhoid and iNTS control. The conference’s lively panel discussions and presentations shed light on the global progress towards alleviating the needless suffering caused by these diseases.

Typhoid, a severely under-prioritized public health problem, impacts an estimated 21 million people every year, causing more than 216,000 deaths annually — predominantly among children younger than 15 years of age. However, recent progress in vaccine development, technology transfer and disease surveillance is bringing the world several steps closer to typhoid control.

The conference began with a welcome reception, featuring opening remarks from Brian Davis, Chief Operating Officer of the Sabin Vaccine Institute; Dr. Anita Zaidi, Director of the Enteric and Diarrheal Diseases program at the Bill & Melinda Gates Foundation; and Dr. Pretty Mulihartina, Director of the Center for Biomedical Technology of Health, NIHRD in Indonesia. Each speaker highlighted the tremendous burden that typhoid and iNTS disease place on communities and families, while providing insight into the promising new research and development being carried forward by many of the conference’s participants.

The welcome reception was followed by three days of discussions and presentations focused on topics such as global disease burden; risk factors for typhoid, paratyphoid, and iNTS disease; disease modelling; water, hygiene, and sanitation (WASH) interventions; antimicrobial resistance; genomics; vaccine implementation strategies; and vaccine development.

Since the Coalition against Typhoid’s last international conference, key milestones have been achieved towards developing typhoid conjugate vaccines. While Vi polysaccharide vaccines exist for typhoid, these vaccines are not effective in young children. However, new conjugate vaccines can be used in infants starting at six months of age – and they also offer a longer duration of protection. Throughout the conference, presenters from various vaccine manufacturing companies, Gavi, the World Health Organization (WHO) and more provided new information on progress towards developing conjugate vaccines, and highlighted what is required to eventually introduce these vaccines into a country’s national immunization schedule.

Key milestones have also been achieved towards understanding the typhoid and iNTS disease burden. A number of panelists and presenters shared data and research collected from novel surveillance projects in Southeast Asia and Africa. This data is helping the typhoid community better understand who is most affected by typhoid, and where.

The conference also brought to light the emerging incidence of iNTS disease in Africa. For the first time in the conference’s history, a number of presentations were devoted to better understanding the burden of iNTS disease, and what needs to be done to address it. Panel members discussed the need for improved understanding of the epidemiology of iNTS disease in Africa, as there is little knowledge of disease transmission. Until modes of transmission are clearly understood, it will be challenging to design non-vaccine intervention strategies.

The conference closed with a call to action from Dr. Zulfiqar Bhutta from the Hospital for Sick Children. He noted that the Coalition against Typhoid has “come of age” and shown that there is power in collaboration across various areas of typhoid research.

Echoing the views of several other speakers, Dr. Bhutta emphasized the need for increased typhoid and iNTS advocacy activity by Coalition members. He also stressed the need for “champions” in endemic countries that can rally support for prevention and control measures. Additionally, it will be crucial to involve policymakers in future Coalition meetings and activities.